Health Policy Brief Analysis

Policy Brief

To: Erin Hargan

From: Alena Rakhman, PA-S

Date: January 19, 2018

Re: Federal Mandate to Enforce Recommended Immunization Schedule for Children

Statement of Issue: Vaccinations are not only one of the best preventative health interventions but are also cost effective. Currently, vaccinations prevent between 2-3 million deaths every year, and could prevent an additional 1.5 million deaths with improvement in global vaccination coverage. The CDC estimates that among children born in the last 20 years, vaccinations will prevent more than 21 million hospitalizations and 732,000 deaths. In the last decade, the anti-vaccine movement, which includes those who blame the MMR vaccine for autism, have merged with individuals who believe that mercury-based preservative thimerosal contribute to the development of autism and other brain development disorders. Countless studies have disproved the link between vaccines and autism and yet the anti-vaccine movement is growing, and more and more parents choose to opt-out of vaccinating their kids, delaying vaccinations or spacing them out.

The is no US federal law that mandates vaccination. All 50 states require children to be vaccinated against diphtheria, tetanus, and pertussis (DTaP vaccine), polio (IPV vaccine), and measles and rubella (MMR vaccine). All 50 states allow medical exemptions, 47 states allow religious exemptions and 17 states allow philosophical exemptions.
Vaccines save children and their parents time and money. Some vaccine-preventable diseases can result in prolonged disabilities and can take a financial toll such as high medical bills and long-term disability care. Federally funded programs provide vaccines at no cost to children from low-income families.
Vaccine-preventable diseases have not disappeared. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have classified more than 2 dozen diseases as vaccine preventable or potentially preventable. In the US, outbreaks of vaccine-preventable diseases often occur due to nonimmunization or underimmunization. Diseases can also be caused by unvaccinated travelers who visit and return from high-risk or endemic regions.
Individuals rely on herd immunity when opting out of vaccinations. Why should I vaccinate my child if there is no sign of disease? Because the majority of the population has been vaccinated, making it is difficult for infectious diseases that are contagious to spread. Individuals who are immunocompromised, the elderly, individuals undergoing chemotherapy and have a weakened immune system, newborns who are too young to be vaccinated, individuals with HIV, individuals who are ill in medical facilities, pregnant women or nursing mothers, and those with a severe allergy to any component of the vaccine are unable to receive vaccinations and have no choice but to rely on the rest of the population.

Policy Options

A federal mandate for allowing only medical-exemptions from immunizations. Medical exemption must be written either by a medical doctor, doctor of osteopathy, physician assistant or a nurse practitioner. State public health officials will review and reject the medical exemption if they don’t believe the exemption is justified or because it does not conform to federal (CDC) vaccine contraindication guidelines. Parent or legal guardian will have an option to file an appeal if they believe the rejection was unjustified.
- Advantages: Children who are either allergic to vaccine components or are immunocompromised will be exempt. This mandate will lead to more children getting their immunizations on time, as per CDC guidelines. Religious and philosophical exemptions will not be honored as the health of a whole population is at stake.
- Disadvantages: Violating the First Amendment and the freedom of religion. The US is known for its freedom of speech and religion and not honoring the religion-exemption is violating those rights.
A federal mandate to fine parents or legal guardians for non-compliance if unable to provide proof of vaccination.
- Advantages: Children rely on their parents and legal guardians to protect them and take care of them. Choosing to delay vaccinations or opting-out altogether violates that. Collected fines can be used to fund research on autism.
- Disadvantages: Financial struggles for parents of low socioeconomic status.
A federal mandate for parents and legal guardians to take an educational course on the benefits of vaccines.
- Advantages: There has already been a campaign which was meant to incite fear using statistics of preventable deaths. From June 3, 2007 to July 18, 2015, there have been 152,763 preventable illnesses, 9,028 of preventable deaths, and 0 autism diagnoses scientifically linked to vaccines. Relatable analogies have also been used to encourage vaccinations but have not worked. Therefore, parents and legal guardians should attend an education course which will focus on scientific facts and where questions and misconceptions will be addressed.
- Disadvantages: A mandatory course for parents/legal guardians is difficult to implement. An online course will be more realistic but there will be uncertainty if individuals actually completed it. Also, it will be more difficult to address any questions that may come up.

Policy Recommendation: With the rising anti-vaccine movement, no federal law that mandates vaccinations, and some states allowing religious and philosophical exemptions, quick reform is necessary to make sure that preventable diseases that can be eradicated do not come back. A federal mandate that ensures the CDC’s recommended immunization schedule for children is followed will ensure that all children receive necessary vaccinations that are on time, unless there is a medical reason why they cannot receive them. Parents and legal guardians that violate the mandate will be fined, and those resources will be used to fund autism research. Additionally, several campaigns that used either shocking statistical facts or analogies have failed, which is why it would be beneficial for parents and legal guardians to complete a mandatory educational course regarding vaccines, which will address any misconceptions.

Sources:

http://www.who.int/features/factfiles/immunization/en/

https://reference.medscape.com/features/slideshow/vaccine-preventable-diseases

http://vk.ovg.ox.ac.uk/herd-immunity

https://www.cdc.gov/vaccines/vpd/should-not-vacc.html

https://vaccines.procon.org/view.resource.php?resourceID=003597

http://www.berkeleywellness.com/healthy-community/contagious-disease/health-care-policy/article/vaccines-save-more-lives

https://www.cdc.gov/vaccines/partners/childhood/matte-articles-5-reasons.html

https://www.csicop.org/si/show/anti-vaccination_movement

http://www.nvic.org/faqs/vaccine-exemptions.aspx

https://www.aclu.org/other/your-right-religious-freedom

http://www.slate.com/articles/health_and_science/medical_examiner/2016/07/vaccination_should_be_mandatory_but_it_isn_t.html